Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis
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{"title"=>"Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Jürgen", "last_name"=>"Barth", "scopus_author_id"=>"56661767100"}, {"first_name"=>"Thomas", "last_name"=>"Munder", "scopus_author_id"=>"56592623500"}, {"first_name"=>"Heike", "last_name"=>"Gerger", "scopus_author_id"=>"21734537600"}, {"first_name"=>"Eveline", "last_name"=>"Nüesch", "scopus_author_id"=>"36882597100"}, {"first_name"=>"Sven", "last_name"=>"Trelle", "scopus_author_id"=>"55907605200"}, {"first_name"=>"Hansjörg", "last_name"=>"Znoj", "scopus_author_id"=>"23993081200"}, {"first_name"=>"Peter", "last_name"=>"Jüni", "scopus_author_id"=>"7004263326"}, {"first_name"=>"Pim", "last_name"=>"Cuijpers", "scopus_author_id"=>"7005376994"}], "year"=>2013, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"369013964", "sgr"=>"84878278370", "pmid"=>"23723742", "scopus"=>"2-s2.0-84878278370", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1001454", "issn"=>"15491277"}, "id"=>"0cfd28d9-240a-37be-98bf-27641136dc2b", "abstract"=>"BACKGROUND: Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.\\n\\nMETHODS AND FINDINGS: We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = -0.62 to d = -0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = -0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = -0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [-0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [-0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.\\n\\nCONCLUSIONS: Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.", "link"=>"http://www.mendeley.com/research/comparative-efficacy-seven-psychotherapeutic-interventions-patients-depression-network-metaanalysis-9", "reader_count"=>284, "reader_count_by_academic_status"=>{"Unspecified"=>8, "Professor > Associate Professor"=>11, "Librarian"=>3, "Researcher"=>36, "Student > Doctoral Student"=>31, "Student > Ph. D. 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Student"=>51, "Student > Postgraduate"=>12, "Student > Master"=>59, "Other"=>21, "Student > Bachelor"=>31, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>6, "Professor"=>11}, "reader_count_by_subject_area"=>{"Unspecified"=>21, "Agricultural and Biological Sciences"=>8, "Philosophy"=>2, "Business, Management and Accounting"=>1, "Computer Science"=>2, "Economics, Econometrics and Finance"=>1, "Engineering"=>1, "Environmental Science"=>1, "Nursing and Health Professions"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>50, "Neuroscience"=>3, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>177, "Social Sciences"=>14}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>50}, "Social Sciences"=>{"Social Sciences"=>14}, "Psychology"=>{"Psychology"=>177}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>21}, "Environmental Science"=>{"Environmental Science"=>1}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Engineering"=>{"Engineering"=>1}, "Neuroscience"=>{"Neuroscience"=>3}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>8}, "Computer Science"=>{"Computer Science"=>2}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Philosophy"=>{"Philosophy"=>2}}, "reader_count_by_country"=>{"Greece"=>1, "Canada"=>2, "Netherlands"=>4, "United States"=>4, "Brazil"=>1, "South Africa"=>1, "United Kingdom"=>3, "Italy"=>2, "Australia"=>1, "Switzerland"=>1, "Germany"=>1, "Spain"=>2}, "group_count"=>25}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1068374"], "description"=>"<p>Dashes indicate pairs of conditions that have not been compared in a study. Negative signs in the upper triangle indicate superiority of the condition in column; negative signs in the lower triangle indicate superiority of the condition in the row. Significant effects are printed in bold.</p>a<p>These confidence intervals are calculated by method of moments random effects meta-analysis.</p>b<p>If only a single comparison was present no credibility intervals are presented.</p><p>n.e., not estimated.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy", "sizes", "psychotherapeutic", "interventions", "meta-analysis"], "article_id"=>707392, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.t003", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Relative_effect_sizes_and_95_credibility_intervals_of_psychotherapeutic_interventions_and_control_conditions_from_conventional_meta_analysis_upper_triangle_and_network_meta_analysis_lower_triangle_/707392", "title"=>"Relative effect sizes (and 95% credibility intervals) of psychotherapeutic interventions and control conditions from conventional meta-analysis (upper triangle) and network meta-analysis (lower triangle).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-28 02:03:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068375"], "description"=>"a<p>The percentages do not add up to 100% because many studies contained more than one treatment.</p>b<p>The percentages do not add up to 100% because not all studies contained a control condition.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy", "198", "studies", "included"], "article_id"=>707393, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.t002", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_study_characteristics_across_the_198_studies_included_in_the_network_meta_analysis_/707393", "title"=>"Summary of study characteristics across the 198 studies included in the network meta-analysis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-28 02:03:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068376"], "description"=>"<p>Negative effect sizes indicate superiority of the specific intervention against waitlist.</p>a<p>Two trials contributed to both strata, one trial did not contribute.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy"], "article_id"=>707394, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.t004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Influence_of_patient_population_intervention_format_study_quality_and_study_size_on_the_results_of_network_meta_analysis_/707394", "title"=>"Influence of patient population, intervention format, study quality, and study size on the results of network meta-analysis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-28 02:03:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068377"], "description"=>"<div><p>Background</p><p>Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.</p><p>Methods and Findings</p><p>We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range <i>d</i> = −0.62 to <i>d</i> = −0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range <i>d</i> = 0.01 to <i>d</i> = −0.30). Interpersonal therapy was significantly more effective than supportive therapy (<i>d</i> = −0.30, 95% credibility interval [CrI] [−0.54 to −0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δ<i>d</i> = 0.29 [−0.01 to 0.58]; <i>p</i> = 0.063) and large size (Δ<i>d</i> = 0.33 [0.08 to 0.61]; <i>p</i> = 0.012) and those that had adequate outcome assessment (Δ<i>d</i> = 0.38 [−0.06 to 0.87]; <i>p</i> = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all <i>d</i>>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.</p><p>Conclusions</p><p>Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy", "efficacy", "psychotherapeutic", "interventions", "patients"], "article_id"=>707395, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454", "stats"=>{"downloads"=>15, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparative_Efficacy_of_Seven_Psychotherapeutic_Interventions_for_Patients_with_Depression_A_Network_Meta_Analysis_/707395", "title"=>"Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-28 02:03:15"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068370"], "description"=>"<p>Flowchart of study inclusion.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy"], "article_id"=>707388, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.g001", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flowchart_of_study_inclusion_/707388", "title"=>"Flowchart of study inclusion.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-28 02:03:08"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068371"], "description"=>"<p>ACT, behavioural activation; CBT, cognitive-behavioural therapy; DYN, psychodynamic therapy; ES, <i>d</i> effect size; IPT, interpersonal therapy; PLA, placebo; PST, problem solving therapy; SST, social skills training; SUP, supportive counselling; UC, usual care; WL, waitlist.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy", "trials", "moderately", "sized"], "article_id"=>707389, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.g002", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Networks_of_evidence_of_all_trials_A1_moderately_sized_trials_B1_and_large_trials_C1_/707389", "title"=>"Networks of evidence of all trials (A1), moderately sized trials (B1), and large trials (C1).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-28 02:03:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068372"], "description"=>"<p>ACT, behavioural activation; CBT, cognitive-behavioural therapy; DYN, psychodynamic therapy; IPT, interpersonal therapy; PST, problem solving therapy; SST, social skills training; SUP, supportive counselling.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy", "psychotherapeutic", "compared", "waitlist", "trials", "moderately", "sized"], "article_id"=>707390, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.g003", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Efficacy_of_different_psychotherapeutic_intervention_compared_to_waitlist_of_all_trials_A2_moderately_sized_trials_B2_and_large_trials_C2_/707390", "title"=>"Efficacy of different psychotherapeutic intervention compared to waitlist of all trials (A2), moderately sized trials (B2), and large trials (C2).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-28 02:03:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/1068373"], "description"=>"<p>Description of intervention strategies.</p>", "links"=>[], "tags"=>["Clinical research design", "meta-analyses", "Mental health", "psychiatry", "Mood disorders", "therapies", "psychotherapy"], "article_id"=>707391, "categories"=>["Medicine"], "users"=>["Jürgen Barth", "Thomas Munder", "Heike Gerger", "Eveline Nüesch", "Sven Trelle", "Hansjörg Znoj", "Peter Jüni", "Pim Cuijpers"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001454.t001", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Description_of_intervention_strategies_/707391", "title"=>"Description of intervention strategies.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-28 02:03:11"}

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Relative Metric

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